Some COVID-19 Patient Revisits to Hospitals Could Have Been Prevented, Study Finds

Some patients who were hospitalized with COVID-19 could have avoided a return visit with better post-discharge plans and communication, a new study has found.

The study in The Joint Commission Journal on Quality and Patient Safety examined those who revisited the hospital within 30 days. About a quarter of those revisits could have been prevented and the author said those cases provide instructive lessons.

Some preventable situations included a misunderstanding of discharge medications by either the patient or caregiver or the inappropriate choice of a discharge location. Conversations with patients and caregivers should focus on whether going home is the best option or if patients need more care than they’ll get at home, the authors wrote.

Other factors identified included patients simply being discharged too soon or without a needed procedure or inadequate treatment of medical conditions.

Kendall G. Fancher and Mark V. Williams wrote in an editorial that accompanied the study that hospitals must be mindful of risk factors that could lead to revisits.

“This study emphasizes that among patients with COVID-19, the vast majority of readmissions still fall under broad categories of risk factors that plagued our national healthcare system before the pandemic,” they wrote. “Hospitals and clinicians must continue to review known fundamental risk factors for high-risk readmissions and address them.”

The study examined COVID-19 patients treated at an academic medical center. The authors found 13.2% of those patients revisited the hospital within 30 days. About a quarter (26%) of those revisits could have been prevented, the study found.

The study focused on 576 COVID-19 patients who had been treated and discharged from an academic medical center between March 21 and June 29, 2020. The study found 76 patients had revisits for preventable reasons, including 21 who were seen in emergency departments but did not require readmission to the facility.

Of the 55 patients who had to be readmitted, five died or were sent to hospice, while another 5 were readmitted twice within that 30-day period.

While the authors described the percentage of preventable readmissions as low, they nonetheless said there are lessons that can be learned.

The findings of the study carry implications beyond the COVID-19 pandemic. The authors said better communication with patients and caregivers can reduce the chances of a return visit to an emergency department or readmission.

The authors recommended that healthcare providers carefully go over the discharge plan with patients and caregivers to make sure they understand it and can follow through with it. In nearly two-thirds of the readmissions examined, reviewers determined that focusing on improvement in the self-management plan after discharge from the medical center could have prevented a return visit.

The authors also noted the use of videoconferencing between the patient, caregivers and the healthcare team can be a valuable tool to help explain the discharge plan. Videoconferences offer caregivers the chance to raise concerns if the patient has deteriorated significantly and if their condition may be too challenging to manage at home.

“Self-management planning involves educating patients and caregivers about medication changes, follow-up appointments, and symptom management,” the authors wrote.

“Moreover, it involves shared decision making about whether the self-management plan is feasible, or whether functional or cognitive limitations necessitate additional home services or discharge to a skilled nursing facility,” the authors wrote. “Improvement in self-management planning has been identified as an important intervention in pre-pandemic studies.”

In treating COVID-19 patients, providers must also focus on management of other chronic diseases, such as congestive heart failure, diabetes or renal failure, the authors wrote. Patients who were readmitted showed worsening symptoms of chronic diseases.